Provider Demographics
NPI:1518193978
Name:BLOCK, PEGGY RICHARDSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:RICHARDSON
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1799
Mailing Address - Country:US
Mailing Address - Phone:270-247-0200
Mailing Address - Fax:270-247-6409
Practice Address - Street 1:401 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1799
Practice Address - Country:US
Practice Address - Phone:270-247-0200
Practice Address - Fax:270-247-6409
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist